How user centred design can support good digital strategy

Ivanka Majic profile picture

06 April 2021

Ivanka Majic
User Research Specialist
Public Digital


Delivering great digital services means developing a deep understanding of your users and their needs. NHS trusts are increasingly finding ways to do this so they can get closer to their users' experience of their digital services. This understanding is crucial as many trust boards look to refresh or review their digital strategies following the progress made during COVID-19.

As a user researcher I've had the chance to participate in a number of board sessions as part of the Digital Boards programme. Here is some of the advice I've had for NHS trusts.


Staff are users too


Every system - especially in health - will have multiple audiences and multiple users. When being user-centred you need to consider patients, clinical staff, and administrative staff. Observing administrators as they work is an incredibly rich way of uncovering system solutions that are sub-optimal. Have they created cheat sheets? Do they have post-its with little reminders stuck to their screens? What spreadsheets and checklists have they squirreled away to help them do their jobs better? What do they call things? How many trusts are relying on paper or spreadsheets to failsafe digital systems? Why? What is missing from the technology and what is stopping staff from trusting them with our health?


Think about the whole journey


The tendency to fix a problem at its most visible point is not unique to the NHS. Watching people, letting them show you or walk you through what they actually do in order to complete a task will undoubtedly surface a number of unintended glitches that stop people or slow them down. Watch people navigate the car park or a building or find something on your website. As a board, read a standard letter out loud or set yourselves the task of finding a specific piece of information on your site. All of these are excellent ways to check in with the everyday realities for your users.


Survey results are not the same as understanding your users


Surveys can be an excellent way of getting a snapshot of how people are feeling. We have been told about satisfaction surveys conducted during the first 6 months of COVID-19 where patients reported feeling satisfied with the virtual consultations they had while staff were dissatisfied with the service they were providing. In order to make any decisions about the service we would need to understand why patients and staff feel that way. Conducting a conversation over video is a particular type of communication and staff might feel uncomfortable or lacking in skills - this could be resolved by training. If the reason they are dissatisfied is that their equipment is poor and the video connection is lacking in quality  a very different solution is required. We need the "why" in order to implement the right solution.


Consider your edge cases


In user-centred design we often speak about the edge cases vs. the average case. By considering the edge cases we are forced to think harder about our designs, and often make things easier for many people. Providing a wheelchair ramp, wider doors, or automatic doors definitely makes it easier for wheelchair users to access the building but it also makes it easier for people pushing prams, or dragging shopping trolleys, or any who prefer to avoid touching doors in public spaces.

You will all recognise that having a well completed form is incredibly useful even if the means to respond are phone or a physical address.

Ivanka Majic    User Research Specialist

Is there a large population of digitally excluded people in your area? If so, it might be useful to consider your digital experiences as if they will always be accessed on a shared device in a library, or on a low grade smartphone with poor connectivity. I am often reminded of the adult social care system provider whose service required each applicant to have an email address. You will all recognise that having a well completed form is incredibly useful even if the means to respond are phone or a physical address. You will also understand that for a digitally excluded population an email address is unlikely.

It is worth asking: are there many 'digital natives'? What will they expect? How tolerant will they be of poorly designed forms or screens that don't work well on mobile devices? Designing for high digital literacy can present its own unique challenges in terms of expectations.

It is also important not to assume. During COVID-19 a carers support group reported that teenagers were the least comfortable with video meet-ups particularly for groups where they didn't already know each other. This may not be surprising for people who work with teenagers all the time but many of us might assume that they would be comfortable with all manner of digital communication.

Perception is a critical part of user comfort with any system and as long as medics feel that a digital solution is a negative compromise digital transformation is a challenge.

Ivanka Majic    User Research Specialist

Your most challenging users might be highly skilled surgeons or consultants for example. Highly qualified clinicians may be able to navigate most technology systems but it doesn't mean they want to. The challenge of adoption for them might be much more grounded in a lack of trust or a perception that it compromises care. After all, taking personal responsibility is part of a medic's role while IT systems don't always appear to adhere to the same high standards. Perception is a critical part of user comfort with any system and as long as medics feel that a digital solution is a negative compromise digital transformation is a challenge.

As a board taking the time to consider who these edge cases are will undoubtedly result in an excellent and useful debate.


Don't wait


Ideally you will have a team of people who understand user research, who understand and can use data gathered in surveys, via social research, via website analytics,  and conduct and commission useful primary research. Whether you do or not should not stop you taking the time to better understand your service users and their experience of your service. Start your next meeting by trying to book an appointment with the service you represent.

About the author

Ivanka Majic profile picture

Ivanka Majic
User Research Specialist

Ivanka Majic is a user researcher, service designer and service manager. At the Government Digital Service, she was service manager for Digital Marketplace from inception to beta, setting the strategy for a digital product which has continued to deliver savings for government and has since seen £4 bn in sales, with 45% going to SMEs.

Previously, Ivanka was creative strategy lead/head of design at Ubuntu, leading its brand and product transformation from open source project to consumer product, and head of user research at LBi (now Digitas). She has extensive experience in the UK public sector, working at the Department for Transport, Department for Work and Pensions, the Ministry of Communities, Housing and Local Government, and Brighton and Hove Council.

Ivanka holds a masters in human centred computer systems and degree in electronic engineering. She is an associate at The University of Sussex, teaching user centred design to product design foundation students.

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